Healthcare Provider Details

I. General information

NPI: 1104740521
Provider Name (Legal Business Name): JENNIFER LYNN ENGEL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E H ST
IRON MOUNTAIN MI
49801-4760
US

IV. Provider business mailing address

325 E H ST
IRON MOUNTAIN MI
49801-4760
US

V. Phone/Fax

Practice location:
  • Phone: 906-863-1286
  • Fax: 906-779-7453
Mailing address:
  • Phone: 906-863-1286
  • Fax: 906-779-7453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number23722630
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: